A diagnostic score to predict the difficulty of a laparoscopic cholecystectomy from preoperative variables.
BACKGROUND
Modified logistic regression analysis of 24 variables in 300 patients undergoing laparoscopic cholecystectomy found the following parameters independently predictive for a difficult operation: right upper quadrant pain (p < 0.01), rigidity in right upper abdomen (p < 0.01), previous upper abdominal surgery (p < 0.01), biliary colic within the last 3 weeks (p < 0.05), white blood cell count > 10 x 10(9)/l (p < 0.05), thickening of the gallbladder wall (p < 0.05), hydroptic gallbladder (p < 0.05), pericholecystic fluid (p < 0.01), shrunken gallbladder (p < 0.01), and no filling of the gallbladder in preoperative intravenous cholangiography (p < 0.05).


METHODS
Based on these variables a diagnostic model was developed to predict the difficulty of a laparoscopic cholecystectomy, with scores ranging from 0 (ideal case) to IV (conversion to open cholecystectomy expected) prior to surgery.


RESULTS
When the reliability of our model was examined in a second study in 340 consecutive patients undergoing laparoscopic cholecystectomy 80% of the patients were predicted correctly.


CONCLUSIONS
Our model should help to select patients for either laparoscopic or open cholecystectomy based on the expected difficulties and the experience of the surgeon.
Schrenk
P
P
Ludwig Boltzmann Institute for Surgical Laparoscopy, Linz, Austria.
Woisetschläger
R
R
Rieger
R
R
Wayand
W U
WU
D000208:Acute Disease; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D003657:Decision Making; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results; D012307:Risk Factors